ENDOTHELIAL KERATOPLASTY: INDICATIONS AND OUTCOMES IN A TERTIARY CARE CENTER IN LEBANON.

This study aims to assess the indications and outcomes of Descemet membrane endothelial keratoplasty (DMEK) surgeries in Lebanon, where tissues are imported. Focusing on visual acuity (VA) improvement and central corneal thickness changes (CCT). Additionally, the study investigates factors influencing surgical outcomes, including tissue preparation methods, donor characteristics, intraocular pressure (IOP), and time intervals from tissue procurement to transplantation.

Tertiary care center in Lebanon, a developing country where tissues are imported from abroad.

This retrospective chart review analyzed 86 DMEK surgeries performed on 78 patients between 2016 and 2023, examining the following outcomes: CCT and VA measured preoperatively and up to one-year post-DMEK. Variables of interest included the rate of rebubbling, IOP, tissue preparation methods (preloaded, surgeon-prepared, or prepeeled/precut tissue), donor age, endothelial cell count, time from death to preservation, time from preservation to surgery, and time from death to transplant. The goal was to explore the relationships between these variables and the clinical outcomes.

Among the 86 DMEK surgeries, the indication for surgery were pseudophakic bullous keratopathy (53.5%), graft failure (19.8%), Fuchs' endothelial corneal dystrophy (19.8%), herpes keratitis (2.3%), and others. Postoperative elevation in IOP occurred in about 36.5% of patients. CCT significantly decreased across all time points compared to baseline, with rapid changes in the first month post-operation. The rebubbling rate was 28.7% and rebubbling was associated with higher CCT over the first month (p=0.027) but not over the entire year. Donor age did not affect the outcomes. VA improved significantly by month 5 and stabilized afterward. The mean time from death to preservation was 0-1 day, with no significant association found between this interval and CCT or logMAR progression over 1 year (p=0.129 and p=0.390). The mean time from preservation to surgery was 9.6 days, and from death to transplant was 10.2 days, with no significant correlations observed for either interval and outcomes (p>0.09). The tissue preparation technique used showed no significant association with post-operative CCT progression over the year (p=0.320 and p=0.221) or in VA outcomes (p=0.829 and p=0.794).

Despite challenges posed by limited healthcare resources and economic constraints in Lebanon, DMEK surgery has shown promising outcomes in improving VA and CCT. Vigilant monitoring and management of postoperative complications, particularly elevated IOP, are essential. Addressing systemic barriers to healthcare access and enhancing corneal transplantation infrastructure are crucial for ensuring equitable delivery of advanced ophthalmic care in resource-limited settings.